Here are a few things worth noting on the Web today. At Code Blog, “Rookie Mistake” is illuminating on the subject of switching nursing specialties. Here’s a short excerpt:

My new hospice job is going pretty well. I really like it. It’s been an adjustment, but worth the stress of change.

Overall, I’ve been pretty surprised at how little I know/knew about how people die naturally.

In ICU, if you are actively dying, you look terrible. In most cases, people dying in the ICU are there because we were or are trying to save their life. This requires some treatments that cause other problems. . . . That is what dying looked like to me for 14 years. Turns out it’s a pretty exaggerated version of how it is when people naturally die without life-saving interventions.

In other news, Kaiser Health News reports that the Joint Commission is releasing its annual list of hospitals that have done well in following certain crucial procedures and protocols:

The commission is recognizing 620 hospitals (download list as PDF or .xls file) – 18 percent of those it accredits — as “top performers” for following recommended protocols at least 95 percent of the time.

Congrats to those who made the list. But a caveat: The article does note that there’s “an ongoing debate” about whether process measures or outcome measures better reflect quality of care. And in truth, we’ve heard complaints from many nurses about process measures and their potential unfairness/inaccuracy. What’s your take?

Lastly, “At the Eye of the Storm,” this month’s AJNReflections essay, is by a nurse who describes the struggle to make the right decision, along with siblings, about her gravely ill father’s care. Wanting to avoid overly aggressive measures, she nevertheless does her best to respect what her father would have wanted.